Published: 5 June 2009 Received: 27 May 2009
Human Resources for Health 2009, 7:45 doi:10.1186/1478-4491-7-45 Accepted: 5 June 2009
This article is available from: http://www.human-resources-health.com/content/7/1/45
2009 Anderson et al; licensee BioMed Central Ltd.
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Abstract
Pharmacists' roles are evolving from that of compounders and dispensers of medicines to that of
experts on medicines within multidisciplinary health care teams. In the developing country context,
the pharmacy is often the most accessible or even the sole point of access to health care advice
and services.
Because of their knowledge of medicines and clinical therapeutics, pharmacists are suitably placed
for task shifting in health care and could be further trained to undertake functions such as clinical
management and laboratory diagnostics. Indeed, pharmacists have been shown to be willing,
competent, and cost-effective providers of what the professional literature calls "pharmaceutical
care interventions"; however, internationally, there is an underuse of pharmacists for patient care
and public health efforts. A coordinated and multifaceted effort to advance workforce planning,
training and education is needed in order to prepare an adequate number of well-trained
pharmacists for such roles.
Acknowledging that health care needs can vary across geography and culture, an international
group of key stakeholders in pharmacy education and global health has reached unanimous
agreement that pharmacy education must be quality-driven and directed towards societal health
care needs, the services required to meet those needs, the competence necessary to provide
these services and the education needed to ensure those competence. Using that framework, this
commentary describes the Pharmacy Education Taskforce of the World Health Organization,
United Nations Educational, Scientific and Cultural Organization and the International
Pharmaceutical Federation Global Pharmacy and the Education Action Plan 2008-2010, including
the foundation, domains, objectives and outcome measures, and includes several examples of
current activities within this scope.

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Introduction
Access to essential medicines is one of the most basic
health services. To ensure access to and appropriate use of
medicines, there is a need for an appropriately-trained
pharmacy workforce. Unfortunately, pharmacists and
pharmacy support personnel in many countries are too
few in number and trained at a critically insufficient scale.
Pharmacists represent the third largest health care profes-
sional group in the world after nurses and doctors. The
ratio of the pharmacy workforce to population varies
widely between countries, from 0.8 per 10 000 popula-
tion in the African region to 5.4 in the Americas [1]. For
example, at present there is one pharmacist for every 1300
people in the United Kingdom, but in Uganda, there is
only one pharmacist for every 140 000 people, and local
health authorities estimate that this figure represents only
one third of the required pharmacist workforce. The scal-
ing up and quality improvement of pharmacy education
and training are essential for addressing workforce short-
ages and for meeting basic health needs.

The international shortage of health care professionals
exists in different severities and has different root causes,
depending on the particular health profession and the
country of origin. In addition, even with adequate num-
bers of health care providers, because health care priorities
differ between countries, one universal health workforce
model would invariably not provide services tailored effi-
ciently to all those who need them. Still, due to the
increasing overlap of professional roles and team-based
clinical services, it is essential that countries consider all
health professionals, including pharmacists and phar-
macy support personnel, when developing workforce
plans [2].

Appropriate use of medicines
The United Nations Working Group on Access to Essential
Medicines has advised that any attempts to strengthen the
health system to improve access to and appropriate use of
medicines will be undermined without tackling the
underlying pharmacy workforce shortages and imbal-
ances [1]. This is advice that some countries are adopting,
albeit slowly.

In case reports from across the globe, pharmacists and
pharmacy support personnel have been shown to be will-
ing, competent and cost-effective providers of patient-
focused and medicines-centered care (termed "pharma-
ceutical care" in the professional literature) to individuals
and populations. Pharmacists' roles are evolving from
that of compounders and dispensers of medicines to that
of medicines experts within multidisciplinary health care
teams. In the developing-country context, the pharmacy is
often the most accessible or even the sole point of access
to health care advice and services.

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Because of their knowledge of medicines and clinical ther-
apeutics, pharmacists are suitably placed for task shifting
in health care and could be further trained to undertake
functions such as clinical management and laboratory
diagnostics. Pharmacy personnel are also ideally placed
for public health roles, although this function remains
largely untapped. Indeed, the underuse of the pharmacy
workforce for preventive and treatment-based roles is
widely acknowledged [3-6]. To improve health outcomes,
a coordinated and multifaceted effort to advance work-
force planning, training and education is needed.

Defining pharmacy education
For the intents and purposes of the Taskforce, when using
the term pharmacy education, it is to be understood that
this refers to the educational design and capacity to
develop the workforce for a diversity of settings (e.g. com-
munity, hospital, research and development, academia)
across varying levels of service provision and competence
(e.g. technical support staff, pharmacists and pharmaceu-
tical scientists) and scope of education (e.g. undergradu-
ate, postgraduate, lifelong learning). This
multidimensional conceptualization embodies a system-
atic approach to education development that enables and
supports a sustainable expert health care workforce to
effectively improve health.

Needs-based education
Needs-based education is a strategy that calls for any given
system to assess the needs of its community and then
develop (or adapt) the supporting educational system
accordingly. Health care demands are incredibly diverse
and complex, often varying widely within and between
regions. Although broad, general frameworks may be ben-
eficial at the macro level; "one-size-fits-all" systems do not
offer the authenticity needed for buy-in and sustainability
at the micro level.

To date, much of the focus on developing the academic
workforce and then practitioners has involved bringing
academics to the developed world for research (PhD) or
practice (MSc in clinical pharmacy or PharmD) training in
institutions of higher education. There has been less con-
centration on developing teachers who can significantly
increase the throughput of high-quality trained pharma-
cists for the workforce.

The United States-Thai Consortium and the Thai-United
Kingdom Collaborative Research Network each represent
ongoing examples of partnership for needs-based training
focused on building capacity in pharmaceutical services
and sciences in Thailand. These programmes, which
include collaborations among 10 Thai schools, 10 United
States schools and 11 United Kingdom schools, allow for
Thai pharmacy students, pharmacy practitioners and sci-

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entists to undertake government-subsidized advanced
pharmacy studies (e.g. clinical and doctoral level) in the
United States and United Kingdom to build capacity for
the academic workforce.

Since inception of these programmes (1993 in the United
States and 2003 in the United Kingdom), approximately
200 Thai practitioners and researchers have completed
studies in the United States and United Kingdom, return-
ing to Thailand as clinicians, educators and researchers.
Continuing annual consultations and "reverse exchanges"
have ensured that the programme is refined and adapted
to remain authentic.

Additional examples of anchoring pharmacy education to
local needs are two sites in Kenya. The Purdue Kenya Pro-
gramme is long-running and has trained more than 50
United States pharmacy students and residents at a hospi-
tal associated with Moi University in Eldoret. Last year the
programme began pairing United States students (Purdue
University School of Pharmacy) with Kenyan pharmacy
students (University of Nairobi School of Pharmacy) to
provide clinical pharmacy services in the hospital.

These student pairs are actively involved with developing
new pharmacy-managed clinics in areas such as diabetes
and anticoagulation services. The United States students
mentor the Kenyans with regard to team-based
approaches to improving care; the Kenyan students men-
tor the Americans regarding the culture and mechanisms
for providing such care in that region.

Pharmacists at Aga Khan University Hospital in Nairobi
are developing a part-time, work-based postgraduate
diploma in clinical pharmacy to be offered to pharmacists
throughout the Nairobi area. These pharmacists will then
be able to educate other local pharmacists and pharmacy
students. Because this programme works with the local
medical and nursing community, it is conjectured that the
enhanced pharmacy services will not be seen as a threat to
existing services, but rather as a complement to them to
enable a team-based approach to health care services.

One of the crucial needs, particularly in developing coun-
tries, is to train pharmacists who have internalized their
role of helping to meet the medicine-related needs of
poorer, less urbanized communities. Few students are
familiar with these settings prior to training and most stu-
dents appear to aspire to work in well-equipped tertiary
hospitals in cities.

Developing a commitment to stay and service these needs
is more likely to occur when the students spend time in
the social laboratory provided at primary health care set-
tings and in patient's homes. Many innovative education

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practices have evolved to fill this gap. For example, in
South Africa, Rhodes University staff members supervise
pharmacy student visits to patients in their homes. Stu-
dents are briefed on the patients' details in advance, and
supported by interpreters. Their role is primarily to detect
medicine-related problems, provide education where this
is appropriate and refer if necessary. This innovative pro-
gramme received the university's first Vice Chancellor's
Community Engagement Award in January 2008 as a tes-
timony of the success of its capacity to address the needs
of a community through experiential learning.

All these examples represent the adaptation of general
educational strategies such as partnering between schools,
seeding research leaders, investment in a train-the-trainers
programme, expanding the clinical portion of the profes-
sional curriculum and engaging communities. Each strat-
egy has been flexible to the pre-existing and future needs
of the community in order to optimize effectiveness. This
further supports the importance of the adoption of a
vision and action plan for global pharmacy that is
founded in local, regional, national and international
needs for health care.

The pharmacy workforce
The scaling up and quality improvement of pharmacy
education and training are essential for tackling workforce
shortages, meeting basic health needs and saving lives.
They form one of the major bottlenecks in expanding the
pharmacy workforce. The capacity to provide pharmaceu-
tical services in each country depends on two workforce
needs: an appropriately trained pharmacy workforce to
provide the services and a competent and committed aca-
demic workforce to train sufficient numbers of new phar-
macists and other pharmacy support staff at both basic
and enhanced levels. Each depends on appropriately
resource academic institutions composed of students
who have the necessary intellectual knowledge, values
and competence to be change agents for health in their
communities. We also anticipate a further demand for
academic pharmacists as continuing professional devel-
opment requirements increase for qualified pharmacists.

One response to the global shortage of pharmacists has
been an increase in the size and number of pharmacy
schools in both developed and developing countries. An
expansion in the number of pharmacy graduates occurred
or was recommended in Australia, Canada, Ireland,
Northern Ireland, the United Kingdom and the United
States [7-11]. There have also been large increases in
China and India.

However, the global data on pharmacy schools are far
from complete. There has been an increase in the number
of pharmacy schools and increases in enrolments at exist-

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ing schools. This strategy has been successful in increasing
the hospital pharmacist workforce in Australia, Ghana
and the United Kingdom. Additionally there may be diffi-
culties at first in ensuring a sufficient number of pre-regis-
tration or residency training posts for an increased
number of graduates seeking to enter the workforce
[12,13]. In many countries, workforce shortages also
apply to academia; capacity to scale up education may
therefore be limited.

Expansion presents many concerns, including its effect on
the quality of teaching, the number of available phar-
macy-trained academic faculty members and the aca-
demic standard of applicants. Higher education funding
policies have often encouraged higher enrolments, which
have not been matched by similar increases in resources,
including staffing levels [8].

Alignment of curricula with actual practice activities is
important for a number of reasons, including job satisfac-
tion and to provide the best health care for patients.
Matowe et al. [14] point out that pharmaceutical practice
differs widely from what students were taught at univer-
sity.

Another misalignment of pharmacy education, high-
lighted in developing countries, is that pharmacy schools
are largely located in urban areas; therefore, the majority
of students are from relatively near the urban centres. This
fact, alongside the fact that the pharmacy curriculum is
similar to that of more developed countries, meant that
graduates have little relevant understanding and skills
required for addressing health problems in rural areas of
their own country; administrators realize that their ambi-
tions are unlikely to be met in these rural locations [15].
A perceived lack of educational and professional opportu-
nities available to pharmacists in Ghana was seen as pre-
venting them from making a full contribution to health
care in Ghana [16].

Recognizing the need to develop a vision for pharmacy
education, ensure a sustainable pharmacy workforce rele-
vant to needs and build the local capacity of pharmacy
higher-education institutions, the International Pharma-
ceutical Federation (FIP) launched the Pharmacy Educa-
tion Taskforce with the World Health Organization
(WHO) and the United Nations Educational, Scientific
and Cultural Organization (UNESCO) in March 2008
after a series of global consultations on pharmacy educa-
tion. The Taskforce is a collection of stakeholders repre-
senting various global, regional and country networks
with the shared goal of coordinating and catalysing
actions to develop pharmacy education. The purpose of
the Taskforce is to oversee the implementation of the

Pharmacy Education Action Plan 2008-2010
Acknowledging that specific health care needs can vary
significantly across geography and culture, an interna-
tional group of key stakeholders has reached unanimous
agreement that pharmacy education must be quality-
driven and directed towards these identified needs, the
pharmaceutical services needed to meet these needs, the
competence needed to provide these pharmaceutical
services and the education required to achieve/ensure
these competence. The action plan aims to: develop a
vision, frameworks, guidelines and case studies; build evi-
dence and advocacy; accelerate country action; and estab-
lish a global platform for dialogue [18]. The Action Plan
is dedicated to four domains of action: quality assurance,
academic and institutional capacity, and competence and
vision for pharmacy education. Each domain of action
represents a work stream that is phased over the three
years to include country case studies, consensus building
and policy guidance. The focus of these case studies is the
sub-Saharan African region, due to the urgency of the
health workforce crisis and extreme pharmacy workforce
shortages.

The Pharmacy Education Action Plan was developed and
refined during two global pharmacy education consulta-
tions convened by FIP [19,20]. It will be actively and con-
tinuously monitored by the Taskforce to assess progress
towards the overreaching goal; i.e. disseminating evi-
dence-based guidance and frameworks that facilitate the
development of pharmacy education (and higher educa-
tion capacity) to enable sustainability of a pharmacy
workforce appropriately skilled to provide pharmaceuti-
cal services. The Global Pharmacy Education Action Plan
2008-2010 represents the greatest opportunity to date for
stakeholders to support, participate, contribute towards
and commit to action for pharmacy education. Figure 1
depicts the Action Plan, a vision for pharmacy education
based on developing competent pharmacists to providing
services based on local needs, goals and outcomes in four
priority domains: quality assurance, academic and institu-
tional capacity, vision for pharmacy education and com-
petence, for each year of the project.

Pharmacy Education Action Plan work streams
Quality assurance
The quality assurance project team is continuing and
advancing the work of the FIP International Forum for
Quality Assurance of Pharmacy Education. This Forum
has collected and examined (national) quality standards
and systems that reflect contemporary pharmaceutical
services and meet the needs of the specific country for
which they were developed. Similar to work of the vision

4th Gobal pharmacy education consultation: guidance
Provide guidance for Review strategies for Identify elements of a Develop a broad
quality assurance capacity development at vision. Develop roadmap competence framework
system development national level, for education that encompasses full
Form recommendations development, scope and all levels of
for academic workforce Form a vision for potential pharmaceutical
institution capacity pharmacy education. service.
development.

and competence project team, these systems have been
examined to identify the principles and core elements of
quality assurance that are unlikely to vary by culture.

From this common ground, an internationally acceptable
quality assurance framework has been proposed and the
first round validation/testing was done via two country
case studies (in Ghana and Zambia). The next round will
involve around 20 countries via an online survey instru-
ment. Four persons from different but relevant perspec-
tives will be targeted to participate from each country.

The project team is working actively with WHO, and has
completed the first draft of a self-assessment instrument
for pharmacy (pharmacist) education. The instrument
uses the format (Structure, Process, Outcomes) and qual-
ity criteria of the Global Framework and was adapted
from a generic self-assessment instrument developed by
WHO, based on the WFME Global Standards [21]. The
draft instrument is undergoing its first round of review
and will then go through a validation/testing phase via
country case studies.

Academic and institutional capacity
The academic and institutional capacity project team is
targeting its work on issues well documented in the med-
ical literature relating to the sustainable development of
the academic workforce, such as disincentives towards
careers in pharmacy academia; absence of clear career
pathways, particularly for clinical teachers; and a culture
that often priorities grants and peer-reviewed publica-
tions over effective teaching efforts [22]. The team is also
exploring cases where poor physical infrastructure (e.g.
safety concerns, absence of even basic facilities, resources
and physical capacity) serve as primary barriers to good
education and capacity building.

An in-depth case study in one African country will inves-
tigate barriers and facilitators to capacity building in phar-
macy education; define roles and responsibilities of
pharmacists in enhancing health in African countries; and
attempt to synthesize innovative strategies to recruiting
and developing the academic workforce We will examine
all the issues with a wide variety of stakeholders at minis-
try, university and practice levels with a view to using this
qualitative data to produce a survey instrument to use
with a number of other countries.

From this work and an analysis of academic workforce
development strategies, evidence-based guidance for the
academic and institutional capacity development will be
generated. The Taskforce is also working with WHO and
the University of Copenhagen on the Avicenna Global
Directories of Education Institutions for Health Profes-
sions, a publicly accessible database of schools, colleges,

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and universities for education of academic professions in
health, including pharmacy [23].

Vision and competence
The vision and competence project team is developing an
"educational roadmap" to guide efforts in and mecha-
nisms for pharmacy education. Countries, particularly
those marginalized by the human resources for health cri-
sis, can use this evidence to develop their workforce and
to track the results of their efforts. This domain of work is
examining existing competence frameworks and use of
these before initiating a consultative and evidence-based
process to develop a broad competence framework for the
pharmacy workforce.

As part of this process, the relationship between culture of
competency (and any perceptions therein) is being
explored. A workshop at the International Social Phar-
macy Workshop in New Zealand (July 2008) first
attempted to explore these ideas, and it is clear that no one
particular competence model will meet the needs of all
parties. However, identifying the core tenets that support
all pharmaceutical services along the continuum from
research to public health and allow for a grounded foun-
dation and framework with flexibility for adaptation
(based on local needs) is a key principle.

UNITWIN Network
One strategic approach that has been adopted by the Task-
force has been to form a partnership with UNESCO, with
the aim of using the experience of a global agency and
coupling this directly to the pharmacy higher education
sector across regions. The designated Global Pharmacy
Education Development Network UNITWIN platform
will act as a conduit for developing consensus and facili-
tating the spread of best practice and educational develop-
ment worldwide. The UNITWIN Network will establish a
resource base and collaborative forum for exchange,
research and capacity building dedicated to tackling chal-
lenges of academic capacity, quality assurance of educa-
tional systems and workforce competence. This is the first
time that a formal global network has been established for
pharmacy education under the stewardship of the profes-
sional body and United Nations agencies.

The capacity to provide relevant pharmaceutical services
in each country depends on an appropriately trained
workforce to provide these services and a competent and
committed academic workforce to provide education and
training at all levels.

Community of Practice
The Taskforce has also formed a Community of Practice
(CoP), an online global platform where Taskforce mem-
bers can view and post documents and resources, take part

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Human Resources for Health 2009, 7:45

in discussions and keep informed of events and activities.
The Taskforce CoP currently connects more than 200 peo-
ple from 56 different countries.

Conclusion
The WHO UNESCO FIP Pharmacy Education Taskforce
provides a conduit and mechanism for collective global
action. The Taskforce objectives are to develop a vision for
pharmacy education; advocate the development of a sus-
tainable pharmacy workforce relevant to needs (health,
education and market); investigate the limited capacity of
pharmacy higher education institutions, particularly in
developing countries; and provide a framework for qual-
ity assurance of pharmacy education. In going beyond the
rhetoric of needs-based education, 2008-2010 marks the
roll-out of the Global Pharmacy Education Action Plan
and thus field testing for learning and sharing to harvest
collective results that spur education development.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
All the authors (CA, IB, DB, TPB, BF, HM, MR, SW, TW,
AY) made substantial contributions to the conception,
design and drafting of this paper and they approve the
publication of this version.

Authors' information
All the authors are members of the Pharmacy Education
Taskforce. CA is a member of the Board of Pharmacy Prac-
tice, International Pharmaceutical Federation, and Profes-
sor of Social Pharmacy, University of Nottingham. IB is
Vice-President of the European Association of Faculties of
Pharmacy and Professor and Head of Education, The
School of Pharmacy, University of London. DB is a Past
President of the American Association of Colleges of Phar-
macy and Professor and Director of Educational Initia-
tives, College of Pharmacy, University of Florida. TPB is
the Director, Capacity Building & Performance Improve-
ment, Management Sciences for Health. BF is an Associate
Professor of the Faculty of Pharmacy, Rhodes University.
HM is Acting Coordinator of Health Workforce Education
and Production, Department of Human Resources for
Health, World Health Organization, Geneva. MR is the
Convener of the International Forum of Quality Assur-
ance in Pharmacy Education, Academic Section, Interna-
tional Pharmaceutical Federation, and a member of the
Accreditation Council for Pharmacy Education ACPE).
SW is the Communications Coordinator of the Pharmacy
Education Taskforce, International Pharmaceutical Feder-
ation. TW is a Project Manager for the International Phar-
maceutical Federation. AY is a Programme Specialist,
Section for Reform, Innovation and Quality Assurance;

Acknowledgements
The authors gratefully acknowledge the contribution of Matthew Marinec
(University of London School of Pharmacy), Sonak Pastakia (Purdue Univer-
sity School of Pharmacy & Moi University School of Medicine), Rosalie
Sagraves (College of Pharmacy, University of Illinois at Chicago), Sital Shah
(Aga Khan University Hospital), and Ellen Schellhase (Purdue University
School of Pharmacy).

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